Innovative Management of a Giant Fibroid in Pregnancy: A Case Report

Uterine fibroids are the most common benign tumors of the female reproductive system, frequently found in women. Although typically asymptomatic during pregnancy, complications can arise in some cases. Management of fibroids during pregnancy often involves a conservative approach, with myomectomy considered after delivery. Alternatively, cesarean or antepartum myomectomy can be tailored according to the patient's needs. In this case report, we present a G2P1 patient who, during her second trimester, experienced increased abdominal girth, pelvic discomfort, constipation, and urinary incontinence. An early multidisciplinary team (MDT) consultation, involving obstetrics and gynecology, general surgery, and urology, identified a massive posterior fibroid as the cause of these obstructive and compressive symptoms. The patient was admitted for symptom relief and ultimately underwent an elective cesarean section at 35 weeks of gestation. The outcome was a live male baby weighing 2.5 kg. Two months later, an interval myomectomy was performed, successfully removing a massive fibroid measuring 22x17x10 cm and weighing 7 kg. While cesarean myomectomy is considered a safe procedure with no greater risk than a cesarean section alone and is also a cost-effective approach, it was not feasible in this case due to the fibroid's proximity to major pelvic blood vessels.